Okayama Tetsuya, Ishikawa Takeshi, Sugatani Kazuko, Yoshida Naohisa, Kokura Satoshi, Matsuda Kiyomi, Tsukamoto Shigeru, Ihara Norihiko, Kuriu Yoshiaki, Nakanishi Masayoshi, Nakamura Terukazu, Kamada Kazuhiro, Katada Kazuhiro, Uchiyama Kazuhiko, Takagi Tomohisa, Handa Osamu, Konishi Hideyuki, Yagi Nobuaki, Naito Yuji, Otsuji Eigo, Hosoi Hajime, Miki Tsuneharu, Itoh Yoshito
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Cancer ImmunoCell Regulation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Cancer ImmunoCell Regulation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Clin Ther. 2015 Jun 1;37(6):1259-69. doi: 10.1016/j.clinthera.2015.03.012. Epub 2015 Apr 7.
We examined the clinical data of patients treated with oxaliplatin to determine the risk factors of oxaliplatin-related hypersensitivity reaction (HSR). In addition, we evaluated the efficacy of rechallenging patients with HSRs with oxaliplatin using prophylactic agents or desensitization procedures.
This study consisted of 162 patients with colorectal cancer (88 men and 74 women) who were treated consecutively at the outpatient chemotherapy department at University Hospital, Kyoto Prefectural University of Medicine. Patients underwent chemotherapy, including oxaliplatin, between March 2006 and June 2012. We analyzed the patients' clinical backgrounds (eg, age, sex, performance status, disease stage, and allergic history) to uncover any connections to the development of HSR to oxaliplatin. In addition, we rechallenged 10 patients who had oxaliplatin-related HSR using prophylactic agents or desensitization procedures.
Of 162 patients, 28 (17.2%) developed oxaliplatin-related HSRs (16, 2, 9 and 1 patient had grade 1, 2, 3, and 4 HSRs, respectively). The total cumulative dose of oxaliplatin at the onset of the HSR was 301 to 1126 mg/m(2) (median, 582 mg/m(2)), and the first reactions developed in these patients after 5 to 17 infusions of oxaliplatin (median, 8 infusions). Logistic regression analysis indicated that sex (male: odds ratio = 3.624; 95% CI, 1.181-11.122; P = 0.024) and eosinophil count in peripheral blood (odds ratio = 35.118; 95% CI, 1.058-1166.007; P = 0.046) were independent variables for oxaliplatin-related HSRs. Rechallenging patients with prophylactic agents was successful in 2 (28.6%) of 7 patients who successfully completed their treatment. On the other hand, all 3 patients rechallenged with oxaliplatin using a desensitization protocol successfully completed their treatment without new HSRs.
In this retrospective study, we observed that being male and having higher counts of peripheral eosinophil could be predictors for HSR to oxaliplatin. In addition, this study confirms that oxaliplatin desensitization protocol allows patients who developed HSRs to continue with their treatment. However, the optimum desensitization protocol for oxaliplatin administration in terms of tolerability and efficacy needs to be defined.
我们研究了接受奥沙利铂治疗的患者的临床数据，以确定奥沙利铂相关过敏反应（HSR）的危险因素。此外，我们评估了使用预防药物或脱敏程序对发生HSR的患者再次使用奥沙利铂进行挑战的疗效。
本研究纳入了162例在京都府立医科大学大学医院门诊化疗科连续接受治疗的结直肠癌患者（88例男性和74例女性）。患者在2006年3月至2012年6月期间接受了包括奥沙利铂在内的化疗。我们分析了患者的临床背景（如年龄、性别、体能状态、疾病分期和过敏史），以发现与奥沙利铂相关HSR发生之间的任何关联。此外，我们对10例发生奥沙利铂相关HSR的患者使用预防药物或脱敏程序进行了再次挑战。
162例患者中，28例（17.2%）发生了奥沙利铂相关HSR（16例、2例、9例和1例患者分别发生1级、2级、3级和4级HSR）。HSR发生时奥沙利铂的总累积剂量为301至1126mg/m²（中位数为582mg/m²），这些患者在接受5至17次奥沙利铂输注后首次出现反应（中位数为8次输注）。逻辑回归分析表明，性别（男性：比值比=3.624；95%CI，1.181-11.122；P=0.024）和外周血嗜酸性粒细胞计数（比值比=35.118；95%CI，1.058-1166.007；P=0.046）是奥沙利铂相关HSR的独立变量。7例成功完成治疗的患者中，2例（28.6%）使用预防药物再次挑战成功。另一方面，3例使用脱敏方案再次接受奥沙利铂治疗的患者均成功完成治疗，且未出现新的HSR。
在这项回顾性研究中，我们观察到男性和外周血嗜酸性粒细胞计数较高可能是奥沙利铂相关HSR的预测因素。此外，本研究证实奥沙利铂脱敏方案可使发生HSR的患者继续接受治疗。然而，需要确定在耐受性和疗效方面奥沙利铂给药的最佳脱敏方案。
